Authors :
Presenting Author: Katherine Horman, MD – Medical University of South Carolina
Sean Horman, BA, MPA – Unaffiliated
Sonal Bhatia, MBBS, MD – Medical University of South Carolina
Rationale:
Infantile Epileptic Spasms Syndrome marked by infantile spasms (IS) typically between ages 3 -12 months.1 These infants are at high risk for cognitive deterioration; etiology and promptness of treatment predict developmental outcomes.1 Unfamiliarity and challenges in recognition of IS semiology contribute to management delays. Most new onset pediatric seizures first present to a Primary Care Provider (PCP) or Emergency Room (ER) often with home videos.2 In our practice, we found that PCPs/ER physicians mostly over or under-diagnose IS when presented with home videos. We aimed to study familiarity with IS semiology and two of its benign mimics, by surveying PCPs using home videos.Methods:
Survey123 of ArcGIS software created a smart survey with capability to display videos, perform qualitative data trends and analysis. PCPs (trainees, attendings, APPs) affiliated with Medical University of South Carolina (MUSC) in the inpatient, outpatient and ER settings received the survey with three videos accompanied by a brief clinical history – two smartphone videos of MUSC patients obtained with parental consent, one publicly sourced video showing IS, shudders and benign sleep myoclonus. Four questions followed each video regarding identification, next steps in management and comfort with the clinical assessment; ten additional questions captured demographic information (Figure 1). Descriptive analysis was used to report the findings.Results:
50/105 trainees, 31/45 attendings, and 2/4 APPs completed the survey. Table 1 outlines the responses: seizure, IS (yes/no), next steps in management and comfort/confidence with clinical assessment. In summary, 40% of responders did not correctly identify IS, 5% of responders incorrectly diagnosed shudders and sleep myoclonus as IS, 58% of responders did not select an acceptable next step (i.e. IS: ER/admit for IS, benign movements: reassurance or monitor); none reported being comfortable in recognizing pediatric seizures by video analyses.Conclusions:
To date, no studies have evaluated accuracy and comfort level amongst PCPs in the diagnosis of IS using home videos. We found that PCPs either under diagnose IS or over-diagnose benign paroxysmal movements as IS indicating unfamiliarity with a neurological disorder with potentially devastating consequences. In general, PCPs were also uncomfortable in recognizing pediatric seizures by video evaluation.
Educational initiatives for PCPs with video-based learning of abnormal pediatric movements may increase familiarity with IS and its benign differentials, thus aiding in timely management.
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1. Zubari SM, Wirrell E, Yozawitz E et al. ILAE classification and definition of epilepsy syndromes with onset in neonates and infants: Position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia. 2022; 63:1349-1397.
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2. Agarwal, RL, Agarwal RR, and Sivaswamy L. How Well Are We Preparing Pediatricians to Manage Seizures and Epilepsy? A Single-Center Questionnaire-Based Pilot Study. Clinical pediatrics 2014; 53(7) 682-688.
Funding: None